Hepatitis A Outbreak in LA: What pregnant women need to know

By Neil S. Silverman, MD
Clinical professor of Obstetrics and Gynecology
David Geffen School of Medicine at UCLA

Concern regarding hepatitis A infection has increased in the setting of recent outbreaks in San Diego and Los Angeles counties, primarily in homeless populations in those areas.

Hepatitis A is a liver infection caused by the Hepatitis A virus. Hepatitis A is highly contagious. While no one really wants to think about it, the truth is that hepatitis A is primarily transmitted by the fecal-oral route, most commonly through consumption of contaminated food or water but also through person-to-person contact. In contrast to other viral hepatitis infections (hepatitis B or C), hepatitis A is a self-limited disease that does not result in chronic infection.

Over 80% of adults with Hepatitis A will have symptoms: if symptoms occur, they usually appear 2 to 6 weeks after exposure (on average 28 days). Symptoms include: fever, fatigue, abdominal pain, jaundice, dark urine, nausea, and vomiting. Antibodies produced in response to a Hepatitis A infection last for life and protect against reinfection. The best way to prevent Hepatitis A, though, is by getting vaccinated.

The current outbreak is not expected to present a large risk to individuals outside the homeless population. However, should exposure to hepatitis A occur in a pregnant woman, either though work or other person-to-person contact, or in response to a restaurant outbreak, post-exposure prophylaxis can and should be given. This consists of giving the first dose of hepatitis A vaccine (which is safe for pregnancy) as soon as possible after exposure, followed by a second dose 6-12 months later. In pregnant women, administration of immunoglobulin in addition to the first dose of vaccine has been recommended as an option by the CA Department of Public Health, especially if the woman’s exposure is through a sexual or household contact: this is also safe for use in pregnancy.